Evaluation of the Rural-Telemedicine program in Nepal : study from the selected districts

Abstract

Telemedicine is growing both in developed and developing countries and has remained as an integral part of health care delivery system. It includes different health activities and medical services that take place at distance. In the developing countries it supports to improve the accessibility, quality and efficiency of the healthcare services and also reduces the cost of service. It also supports to improve the administrative as well as technical aspect of healthcare system.

Government of Nepal has also implemented the rural-telemedicine program in thirty rural-districts hospitals for providing specialist health care services and also to improve the accessibility of health services for the rural community peoples.

Methods: This study explores the existing situation of the rural telemedicine program and the challenges and limitations related with its implementation. Similarly it has also highlighted the roles and responsibilities of the government to improve the program. The study data and information were collected from the selected rural-telemedicine sites and it includes various respondents who were involved in the program and were working at various levels under the government health system. This is a qualitative study with interpretative case study approach. This approach is used since it supports to explore and understand the study area and produce deep insights into the context. For collecting the study data, multiple data collection tools (Semi-structured interview, site observation and discussion) were used. The collected data and information were analyzed and interpreted based on the preconception of the researcher and by comparing them with the concept provided by the Information Infrastructure (II) Theory and Actor-Network Theory.

Results: Study findings shows that the rural-telemedicine service is necessary and important to improve the accessibility and provide specialized healthcare services to the rural community peoples. It has connected the rural-district hospitals with the tertiary level hospital and also supported the health personnel working in the rural areas to get necessary medical support. However the program is facing various challenges due to the lack of sufficient infrastructure and technology that are needed to support the program. Similarly the study findings show that various other factors have also affected the rural-telemedicine program. Such factors are related with the weak policy of government on rural-telemedicine program, limited fund, lack of trained and motivated human resources, frequent and unplanned transfer of the health personnel, unsatisfactory incentives for those health personnel involved in the program and not having supportive environment.

Conclusion: Government need to improve on the existing policy and provide sufficient attention to the program. It is necessary to strengthen the infrastructure and technology and make them user-friendly and culturally adjustable. Similarly it should be cost effective and affordable and supportive to the local technology. For the sustainability of the program, government should also focus on the promotional activities and conduct networking and partnering with the related private organizations and external development partners. Similarly regular training and attractive incentives should be provided to the health personnel to motivate them to work in the rural areas. Government also needs to focus on conducting regular supervision, monitoring and evaluation of the program so that it will provide opportunity to gradually develop the program and timely address the related limitations and challenges.

Keywords: Rural-telemedicine, challenges and limitation, role of government, sustainability, Nepal